The cost of treating stroke victims will soar in the next two decades, according to a study by the American Heart Association and the American Stroke Association that was published in the journal Stroke. Real total direct annual stroke-related medical costs are expected to increase from $72 billion to $183 billion (2010 dollars) between 2012 and 2030.

That’s not the entire story.

“Overall total annual costs of stroke are projected to increase to $240.67 billion by 2030, an increase of 129 percent,” the study states. Indirect costs include lost productivity from morbidity and premature mortality.

The main reason is that “the aging of the United States population in coming decades has the potential to increase stroke cost substantially, because the risk of stroke is higher for older ages.”

Bruce Ovbiagele, MD, the main author of the study, says, “Strokes will absolutely strain the health care system. Only 10 percent recover completely after a stroke.”

Policy changes can help address the problem. The authors cite a study in the New England Journal of Medicine (“Full Coverage for Preventive Medications After Myocardial Infarction,” Dec. 1, 2011 — reporting that “eliminating copayments for relatively inexpensive, commonly used medications for prevention of cardiovascular events resulted in improved medication adherence and reduced the rate of vascular events, while significantly reducing costs for patients — without increasing the insurer’s health care cost.” (This looks like value-based plan design, something we’ve covered for years, including this cover story from 2009 — /archives/2009/8/value-based-insurance-design-spend-little-more-selected-patients-payoff-down-line.)

“Getting patients specialized acute stroke care as soon as possible is critical,” says Ovbiagele, who is a professor and chairman of the department of neurology at the Medical University of South Carolina in Charleston. “During every minute of delayed treatment, brain cells are dying. EMS systems nationwide should take patients directly to a designated stroke center equipped to quickly diagnose and administer drugs to restore blood flow to the brain.”

The study asserts that health reform might alleviate some of the problem. The Affordable Care Act “provides an unprecedented emphasis on the provisions of evidence-based clinical preventive services and calls for a substantial investment in community-based prevention strategies that may help to reduce the growing future burden of stroke.”

Larger aged population means many more strokes

Projected total (direct and indirect) costs of all stroke by age, 2012 to 2030 (in billions of 2010 dollars).

Projected total costs of all stroke by age

Source: “Forecasting the Future of Stroke in the United States,” Stroke, May 2013

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.